Myrtede C. Alfred PhD (is Assistant Professor, Department of Mechanical and Industrial Engineering, University of Toronto.), Dulaney Wilson PhD (is Research Assistant Professor, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina.), Elise DeForest (is Medical Student, College of Medicine, Medical University of South Carolina.), Sam Lawton (is Graduate Student, College of Public Health, Emory University.), Amartha Gore MD (is Obstetrician/Gynecologist, and Locum Tenens OBGYN, Children's Mercy Hospitals, Junction City, Kansas.), Jeffrey T. Howard PhD (is Associate Professor of Public Health, University of Texas at San Antonio.), Christine Morton PhD (is Research Sociologist, Stanford University.), Latha Hebbar MD (is Professor, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina.), Chris Goodier MD (is Associate Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina. Please address correspondence to Myrtede C. Alfred)
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Abstract
Background
Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. The research presented here investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports.
Methods
The authors reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated.
Results
Almost two thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as “other” accounted for 4.0%. NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR 1.25, 95% confidence interval 1.01–1.54).
Conclusion
Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. Although additional systems analysis is necessary, the authors offer recommendations to support safer, more equitable maternal care.
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